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Abstract: TH-PO182

Noninvasive Left Ventricular End-Diastolic Pressure (LVEDP): A Novel Volume Assessment Tool

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Xu, Eric Jia Yi, Johns Hopkins University, Baltimore, Maryland, United States
  • Silber, Harry A., Johns Hopkins University, Baltimore, Maryland, United States
  • Mullangi, Surekha Uma, Johns Hopkins University, Baltimore, Maryland, United States
  • Hwang, Seungyoung, Johns Hopkins University, Baltimore, Maryland, United States
  • Gimenez, Luis F., Johns Hopkins University, Baltimore, Maryland, United States
  • Jaar, Bernard G., Johns Hopkins University, Baltimore, Maryland, United States
  • Shafi, Tariq, University of Mississippi Medical Center, Jackson, Mississippi, United States
Background

Objective assessment of volume is a major barrier to improving volume management in dialysis patients. The Valsalva maneuver is a well-recognized bedside marker of central volume overload. We tested a novel non-invasive handheld device that combines Valsalva maneuver with finger photoplethysmography to reliably estimate LVEDP. The goal of our pilot study was to determine the associations of non-invasive LVEDP measurements with common volume-related hemodialysis parameters.

Methods

We assessed predialysis LVEDP in 67 patients undergoing maintenance hemodialysis at two dialysis units in Baltimore. Patients also underwent extracellular water measurement by bioimpedance (BIA), in addition to routine dialysis parameters. We assessed the association of these parameters with changes in systolic blood pressure during dialysis.

Results

Mean age of the participants was 57 years, 63% were male, and 76% black. Predialysis LVEDP was 16 ± 6 mm Hg (normal: <12 mm Hg) with a range of 5 mm Hg to 33 mm Hg. Among the parameters assessed, only LVEDP was associated with a significant fall in systolic blood pressure (SBP) during dialysis (Table). However, LVEDP was not associated with any of the commonly used definitions of intradialytic hypotension. R2 was 47% for a model of change in SBP that included predialysis SBP, LVEDP, interdialytic weight gain (IDWG), extracellular water, ultrafiltration (UF) volume, UF rate, and treatment time, suggesting that >50% of the variability in the change in SBP during dialysis remains unaccounted for by these variables.

Conclusion

Non-invasive LVEDP is a novel parameter that can provide additional information to guide volume assessment in hemodialysis patients. However, 50% of the variability in the change in SBP remained unexplained, pointing to the need to fully understand the pathophysiology of fall in SBP during hemodialysis.

Predictors of change in SBP (adjusted for age, sex, and race)
PredictorMean ± SDChange in SBP (Post – Pre) per 1 SD decrease in predictor [SE]p
LVEDP, mmHg16.1 ± 5.6-5.4 [2.6]0.04
IDWG, kg2.0 ± 1.3-2.2 [3.3]0.52
Extracellular water by BIA, L20.3 ± 7.2-1.3 [3.3]0.70
Ultrafiltration (UF) volume, L2.4 ± 1.40.3 [3.0]0.93
UF rate, mL/hr/kg7.9 ± 4.8-2.3 [2.8]0.41

SD, standard deviation; SE, standard error

Funding

  • NIDDK Support